Speaker 1 (00:07):
You're listening to the La Jolla Cosmetic Podcast.

Monique (00:14):
Welcome everyone. It's Monique, your hostess of the La Jolla Cosmetic Podcast. Today we have a very special guest, Kara Pennington, physician assistant. We will be talking about who she is, where she comes from, the things she does in the med spa. So we're excited to welcome you, Kara.

Kara (00:36):
Thank you. Thank you for having me.

Monique (00:39):
Tell us about what a PA is and the training behind that and what you do to help patients in our practice.

Kara (00:46):
Of course. So there's different types of mid-level providers. There's nurse practitioners, as well as physician assistants. My program, most of it was... We looked into primary care as well as internal medicine, women's health, pediatrics, across the board there. And then I also received my master's in medical science at Stanford University as part of my training, so I also got to do a little bit of an elective rotation. And I chose to do my elective rotation at your office actually, at LA Jolla Cosmetic. And at that point it became very clear to me that I really enjoyed plastic surgery, as well as just aesthetics in general there.

Monique (01:29):
Interesting. So how did you even know that we could accommodate for your rotation? I didn't realize that connection.

Kara (01:38):
The moment that I found out that I got accepted to Stanford's program, at that point I realized I needed a student ID picture and I was due for my Botox. So I thought, what better place to go than to you guys? I'd had surgery with Dr. Brahme downstairs, previous. And so, at that point I called the office and I thought, I'm going to see Dr. Brahme. And that's when they told me about Lauren and they said she's a face sculptor. You'll love her. She's a physician assistant. I came in and I got treated by her, and then as I talked to her that day, I told her I was going to be going to Stanford. And she said, "I went to Stanford." So we really bonded and she became an excellent mentor, and as the program came towards the end there, we got to choose our elective.

Kara (02:23):
Lauren had asked me before, what do you want to do when you're finished with PA school? And I originally thought I wanted to deliver babies and I wanted to be in women's health. As soon as I spent that day with her in my elective rotation, I was so thankful for that experience because it was immediately that I knew I loved working with women, making them feel good about themselves. It was such a rewarding career path. And I love the art of it, as well as being able to talk to women and share things that normally you wouldn't be able to share with your patients otherwise.

Monique (02:55):
So what was your undergraduate training before you decided to be a PA?

Kara (03:02):
Great question. So it's very different. I took a very weird path. I originally got my bachelor's in journalism and I grew up in Kentucky. So originally I thought I wanted to be a journalist and be the news anchor and be reporting live. And right after I graduated, I worked at NBC downtown here for a short period of time. And it was right away that I kind of realized that it wasn't as rewarding as I anticipated it being. And so I kind of started searching into different fields of medicine, and I worked with a doctor in research at that time and we did nephrology. So it was a lot of patients that had dialysis treatments and we were kind of searching for new medical drugs for them to use generic for.

Kara (03:47):
So at that point, the doctor that I worked with had talked to me about the physician assistant program and he said, "You know I think it would be a great idea for you to look into it." So I looked into it and I had to get several prerequisites before applying, because I didn't really have that science background at all. It took me a good, I would say maybe, extra two years going that route by getting those extra courses, but I wouldn't change it. It was a great experience and I loved having that background in journalism because I think it helped me a lot being able to communicate with my patients.

Monique (04:20):
So tell us about Kentucky. When did you move from there and why?

Kara (04:26):
Yeah. So growing up, I lived in Kentucky, my whole life. My mom still lives there as well as my sister and my nephews. My father though and her had split several years before that, when I was a child. So growing up, they kind of had joint custody of me and my sister, so I would come and visit him in the summer. And he used to live in San Diego and so at that point I got into traveling out here in the summer and what better place to visit? So as soon as I was done with my undergrad, I thought, you know, I think I better go and explore another city. So that's how I ended up in San Diego. Now my dad's in Texas and my mom's in Kentucky, so I have two fun places to visit.

Kara (05:05):
I loved growing up there. I think it was an excellent childhood where you got to play all day and ride your bike and neighborhoods were a lot different than what they are here. A lot more rural. So I really enjoyed that, but it's good to be in San Diego.

Monique (05:18):
Yeah. And how long have you been in San Diego?

Kara (05:21):
I moved out here officially in 2011. So I've been here for quite a while now.

Monique (05:26):
Oh, nice. Okay.

Monique (05:28):
So where are your favorite places to go when you're out exploring?

Kara (05:33):
Encinitas is like one of my favorite places. I love it so much. I love the restaurants there. I love going to the beach. I have a little poodle, so I like taking him to the Del Mar Dog Beach quite a bit, as well as hiking in La Jolla. Torrey Pines has some great areas that I love to hike as well. So on the weekend I try to get as active as possible because we get so many great days of sunshine that it's nice to take advantage of that.

Monique (05:58):
Yes for sure. And does Pierre like to... Pierre's the poodle. Does Pierre like to join you on those hikes or is Pierre more a city dog?

Kara (06:07):
He does. He's definitely getting a little older. He's 12 now. So he loves to keep up with me as much as he can. Sometimes I have to carry him halfway, but that's okay. Gives me a little extra oomf.

Monique (06:20):
Upper body workout.

Kara (06:21):
Exactly.

Monique (06:23):
So in your training with injections for, let's say fillers or sculpting the face, how did you get that training?

Kara (06:35):
Originally like I said, I had done my elective rotation with you guys at the office there, and Lauren Reed, she's also an amazing injector. She's a great trainer. She works for Allergan as well as Galderma. So I really just watched and observed her in the beginning and it's like watching art really. So I've really learned a lot from Lauren as well as I've taken several master injection courses. I just finished with Allergan as well as I've taken some cadaver courses where you really get to dissect it and look at the different tissues and anatomy. So by using those cadaver labs and constantly continuing to learn and doing a lot of CMEs, which are continued medical education.

Monique (07:18):
Now, do you have a favorite procedure or favorite things to do?

Kara (07:23):
I do actually. So I love doing lips. That's my favorite. And the reason is because it doesn't matter if it's somebody that's 20 years old that wants to have their lip done, or if it's somebody that's maybe 90, that doesn't want anybody to know and they just want the tiniest little amount there and they're extremely nervous, they don't want to look overdone. The lips is an area that it feels like it gives you your groove back. And I know it's puffy and it's swollen afterwards, so I always call patients the next day to check on them and kind of walk them off the ledge and let them know this isn't going to be how it's going to stay, although some patients wish it was. But it's one of those areas that's just very unique and I love it. And there's always a lot of interesting stories where somebody has had a childhood injury and we get talking about the scar on the lip and it's always a fun story. So it's that as well as giving women their groove back. The lips are just so, so fun.

Monique (08:20):
Now I know there's a lot of different lip filler products. How do patients know what one to pick or is it better just to come to you and say, this is what I'm looking for, and then you pick out of the... Because there's probably what, four or six or more different things that you could put in your lip. So how do we know which is right for us?

Kara (08:40):
Exactly. That's a great question. So usually I'll kind of talk with patients, especially when it's their first time having a procedure like that done. I'll have them go on Pinterest, go online, find pictures of lips that they like, as well as lips that they don't like, because it's almost just as important to know the goals that they want and what they don't want to look like. That way I can kind of, as a provider, take a look at those photos with them prior to injecting, to really look, to see, okay, what look are they going for?

Kara (09:07):
Some people want just a very subtle lip. Other patients might want something that's a little bit fuller, like a Kylie Jenner. So it's really important as far as picking which product is best for the patient, by looking at the goals that they want to achieve. There's different types of shapes of lips, and depending on the patient's anatomy, we might be able to create that over time. So it's one of those that we just look together and making sure that we're doing it in a very thoughtful way of making sure that we're reaching their goals with the right product, as well as the technique of injecting.

Monique (09:39):
And then, how long do lips stay full? Does it depend on the product or does it depend on the person?

Kara (09:48):
Yeah, so you're exactly right. It does kind of depend on the product there. One of my favorite products for the lip area is called Vollure. It's made by Allergan and it's been studied in studies for it lasting up to 18 months. I do have patients that I see and a year later, it's still there. So it's one that will slowly kind of metabolize. It'll give you a very natural defined lip. It's my go-to. I hate to sound like Paula Deen, but it's like butter. It goes in and I love that product in so many different areas, but I love it because it gives that natural appearance as well as the longevity. I think that area is one that most of us, we have a lot of swelling afterwards. We also have more potential for bruising because it's very vascular there. So the least amount of having to treat that area the better for most of us. So if we're talking about like a Juvederm Ultra Plus, that one product itself could last up to a year, depending on everyone's metabolism. Slowly the products will start to dissolve.

Monique (10:48):
Yeah, that's very interesting. So let me ask you about some things I've been seeing on social media. What is this Russian lip technique? Have you seen this Russian lip?

Kara (10:59):
I have. It's not the look I prefer my patients to have. I've had maybe a handful of patients that request that and it's usually the younger generation and those are also the patients that come back for more and more and more filler. And at that point, I really believe in talking to the patient and explaining to them that we want to balance the face and that we want to keep it within a natural realm. Because if not, there's nothing worse than looking at somebody and knowing that something is fake or it's overly done. That's when we start to look unproportional. And I think that with social media, unfortunately now there's a lot of filters and there's things that cause a lot of young women to want that look.

Monique (11:44):
Now there's also something called the lip flip. Can you explain what that is and how it's achieved and what does it do?

Kara (11:53):
So the Botox lip flip, you have to be the right candidate for that procedure itself. With Botox, it's going to not have the longevity as filler. It's going to last about three months. What the Botox is targeting is going to be the muscle that's located around the lip area. So it might, when we Botox that area, cause a little at different animation. So it does flip the lip out a little bit there, particularly the lateral portion of the lip, where sometimes when we smile our lip disappears or if it's that thinner top lip that we want to kind of flip out there, then you'd be a great candidate for it.

Kara (12:29):
It can particularly be done in a lower dose where it looks natural, as well as it kind of not affecting the animation too much there. That muscle controls pursing, so sometimes giving a really good smooch or wrapping your lips around a straw or swishing mouthwash, those things can be a little bit tricky if the Botox is a little bit too much in that area. So I like to keep it anywhere from like four to six units there, depending on the look that they're achieving and how much we need to roll that border out.

Monique (13:01):
Interesting. And is that the same thing as when we see people who have duck lips?

Kara (13:06):
It could be. It could be that. I try to keep my patients from having that duck lip, that's for certain. So like you said, you'd have to be the right candidate for having that Botox lip flip. But a lot of times I think the duck look is created when patients have had overly filled lips, meaning that they've came in and came in and came in and was never told no, and they just wanted their lips to be fuller and fuller. And a lot of patients of mine now have started to dissolve their lips and waited a little bit to recreate the shape back. Because the lips can only hold a certain amount of filler before it starts to lose its natural shape and start to give off almost like this sausage or duck lip to it. So that filler will migrate or it will have no place to hold in the lip and go out and scatter to the upper portion of the lip itself, and that can give you that ducky, unnatural look.

Monique (14:02):
Interesting. Now, let's say if you get too much filler or something for some reason goes wrong, can that be corrected?

Kara (14:14):
Yes, and I tell all of my patients that are first time filler patients going in, it's scary. And just to reassure them, anything that we're doing with a hyaluronic acid filler, we can use an enzyme, hyaluronidase, which dissolves that so that it's able to be removed safely. So it puts them a little bit of ease knowing that if for some reason there is something that we do together that's undesired, they don't like the outcome, we can always get rid of that. Especially patients that might come in that have had previously placed filler that they're unhappy with, we can remove that as well. And then just doing small amounts at first, until we gain that trust as far as how much swelling they expect to get every time.

Monique (14:57):
Yeah. And I think not everybody realizes, including me, you think, okay, I'm having one syringe of Vollure, let's say. Well, a syringe is what? One milliliter, which doesn't turn out to be very much. I've seen some graphics of like a teaspoon. And how much is...

Kara (15:20):
Fourth a teaspoon.

Monique (15:21):
A fourth of a teaspoon?

Kara (15:22):
Smallest little spoon that you have in your baking counter.

Monique (15:25):
A fourth of a teaspoon is an ml?

Kara (15:27):
Exactly.

Monique (15:28):
Interesting.

Kara (15:29):
In one ketchup package, usually that's about 10 syringes.

Monique (15:32):
Oh my gosh.

Kara (15:33):
If you think about it that way, it's like liquid gold there. So when we talk about areas that we're treating and saying one syringe to the lips and one syringe to this other area, I usually will tell the patients, I don't know for certain until I'm in the depth of the tissue to know exactly how much product I'm going to need. I can guesstimate, but usually I'll be pretty accurate for how much I'm going to need, but if we can get away with less, I certainly try to use less. So as we're working along together, it's a process and I show them the mirror throughout the treatment themselves so they aren't surprised as we are finished as well.

Monique (16:09):
Yeah. And sometimes I think people will think, oh gosh, I had four syringes. Well that actually, you know if you're building up the cheeks, reestablishing some cheek bones or you're chiseling out the jaw and you're doing some lips, you can easily get there and it doesn't mean you're going to look funny, and I think that's the thing for people on my side of the microphone, the patient. That's where it's like four? Oh my God, I had four? You almost think that's going to be too much, but a lot of times that's what you need to sort of reestablish, like you said, that structure and have that more youthful look.

Kara (16:46):
Exactly.

Monique (16:47):
Interesting. So, back to you. So you love doing lips, tell us a couple other things that you've learned over the years that you enjoy treating.

Kara (16:58):
Yeah. My favorite treatment that we offer right now is actually the PDO threads. I love them. I think they're incredible. It's interesting because I started doing the threads about two and a half, almost three years ago now and my ground zero or first patient ever was my stepmom and she still looks great. It's little tweaks here and there that we've done on her over the past couple years together. It's one of the treatments that I feel like really makes women feel good about themselves in a natural way. I call it the gift that keeps giving because naturally right it away they'll be a little bit tighter, but once those absorbable sutures start to break down and build collagen, you're seeing a lifting effect that's so smoothing as well as natural that fillers can't create that in some areas in place. So you really need that in conjunction sometimes with filler, depending on if there's volume loss.

Kara (17:53):
When I have patients come back for their eight week follow up, I ask them, how do you feel? And a lot of them say, I can't tell any difference at all. And I'll pull the pictures out before and after, and then we're both shocked and we're so happy because it really does happened gradually, and it's such a natural thing that the husbands aren't wondering, what have you done? Their friends are wanting to know what they've done because they think they look great.

Monique (18:18):
Amazing.

Kara (18:18):
And it's such a gradual thing.

Monique (18:20):
And like you say, it's really natural. And there's really no downtime with the threads, is there?

Kara (18:26):
I would say I'm always surprised. There's less bruising than I see when I'm doing threads versus fillers sometimes, just depending on the area that I'm treating. I would say the most thing to worry about after threads is that you're going to be a little tender. Big animations, like smiling as well as when you open your mouth to take a bite of food, those might be a little bit tender for up to about 10 days after the treatment itself. So I just tell patients, don't hang out with anybody funny, take smaller bites of food. If you can, try to sleep on your back as much as you can during that first 10 to 14 days to have the best outcome. It's something that patients are so happy with their results that 10 to 14 days goes by very quickly there and it's worth it.

Monique (19:12):
I'll divulge. Kara's done the threads on me and it's stunning because you do see an instant difference, but you also then over time see... I mean, you can see right away, especially when you do one side and you haven't done the other side yet and you're like, whoa, that's amazing. I love seeing your artistry with that.

Kara (19:33):
Thank you. It's so fun.

Monique (19:36):
Can you explain what is a PDO thread? What does that mean?

Kara (19:40):
Yeah. They're made out of an absorbable suture material, very similar to if you were to have a wound or surgery and you have stitches placed in there. Certain stitches obviously have to be removed, but these stitches, these are little guys that are placed onto a little cannula there. There's different types of them that we use, but they all absorb. There's some that we call barbs, which help to lift the tissue the most, and those ones dissolve in about eight weeks. That's usually one of the ones we see that the lifting start to take place, and those are placed a little bit deeper into that subdermal tissue.

Kara (20:14):
Then there's other ones called smooth and twist, and those ones literally look like little acupuncture needles, and they have a tinier little piece of thread on there, which is that absorbable suture. Those ones are placed a little bit more superficially in the depth, so those ones are creating a little bit more collagen and giving your skin a nice glow, as well as helping to support the areas that we're treating with the barbs. So, if you imagine, if we're lifting the cheeks up there, I'll usually use the littler guys, the smoothes, I'll place those along the orbital rim area, which that's usually where that light reflects so it gives your skin that nice glow as well as tightens that area for you.

Monique (20:55):
Interesting. I see. It's so much fun.

Kara (20:57):
It's so fun. It's like we're learning so many new things and I'm always experimenting on myself first. So I always tell everyone, I did this and I wanted to see how it worked out, and it's so amazing that they look so natural.

Monique (21:11):
So when a patient comes to see you for the first time, what can they expect?

Kara (21:17):
Usually I'll tell them to come in with a clean face and we'll take some good baseline photos together, information gather. I tell them not to be too picky because those can look like mugshots for all of us. And then I usually will go in and I'll look from every angle. I really want to look to see areas where they're shadowing that might look like areas of volume loss, as well as areas that we might be able to lift with the threads.

Kara (21:40):
Particularly, I like to ask the patient their main concern because there's nothing worse than going somewhere and someone telling you all these things that you need to have done and you leave the office and you think, "Well, I wasn't even concerned with that", and you feel worse than what you went in. We're always our worst critic too, so there's always times that patients will bring to my eye that there's a line that bothers them or there's something that I didn't particularly even see. At that point, it's like them guiding me is what I like to start with and then we can look as a whole of the facial symmetry as well as trying to balance out things that we can do to help with their overall goals.

Monique (22:22):
So I was just reading one of your reviews and they said, "This was my second visit. Saw Kara both times. She was so knowledgeable on what she was doing. She was careful and precise. Kara has such a welcoming effect and very comforting aura. Made me feel comfortable with receiving lip fillers and absolutely love the results. Kara is amazing at her work and made the whole experience for me, easy and uncomfortable."

Monique (22:50):
I love hearing that you make them feel comfortable, because I think if it's your first time getting a filler you can have some anxiety, and so it's really nice that you have that calming presence that makes them feel comfortable while they're having that procedure.

Kara (23:05):
Thank you. I know. My stepmom, when she came to visit recently and we did some threads and filler on her, she goes, "How do you know?" Because sometimes when I would inject her, I'd say, it's going to feel like I'm in your tooth. Give me a second. And she'd say, "You know exactly what it's going to feel like." I'm like, because I've had it done too. So it's nice having procedures done yourself because then you can firsthand tell patients, this is what you can expect. And I really am conservative and I think that gives patients a little sense of relief of knowing that we can always have them come back to do more if necessary. I really appreciate that patients leave good reviews like that, because that's nice and makes you feel like you're doing the right thing.

Kara (23:49):
They're happy.

Monique (23:50):
I'm scrolling through and you have a 97.6% patient satisfaction rate. There's all five stars. I just scrolled down the whole page. It's pretty amazing.

Kara (24:01):
Thank you.

Monique (24:02):
Yeah. Well, we're lucky to have you our team.

Monique (24:05):
So, last question, which is, for people who haven't maybe listened to our podcast before, if you subscribe to our podcast, you'll get $25 off of $50 or more, all you have to do is show us proof you subscribed. So if you had $25 off of $50 Kara to spend in the med spa, what would you purchase?

Kara (24:29):
Great question. I actually would probably purchase the AlphaRet.

Monique (24:36):
The AlphaRet. That's SkinBetter?

Kara (24:39):
Yes. It's one of my favorite products. My skin is super sensitive. It's really dry. Retin-A's are a little bit too harsh for my skin, so I really love the AlphaRet. It has a really nice technology behind it that I can use every evening and not have to wake up and feel like a lizard.

Kara (24:58):
When I was using the other retinols and retin-A's, I felt like it was never a good medium. I'd use it and then I'd have to stop and I'd get red and flaky. And with that product, I feel like it's given my skin such a nice glow back to it. It's helping to turn the skin cells over at a really nice rate where it's not too harsh and leaving your skin red or dry. I would say that would be definitely something that I would incorporate into your routine for something that if you're starting out and you want to do something or tiptoe in, it really is starting out and doing things topically as well as taking care of your skin. You want to protect your investment.

Kara (25:36):
So using things that are going to help to overall give your results a better result.

Monique (25:42):
Yeah. Like, don't bother getting the filler if you're not going to keep your...

Kara (25:46):
If you're going to go in the sun, and you continue to burn.

Monique (25:49):
And have your skin looking terrible.

Kara (25:51):
Exactly.

Monique (25:52):
That's good. Well, thank you, Kara. It was super fun getting to know you.

Kara (25:57):
Thank you.

Monique (25:57):
And what makes you tick and what your passions are. Awesome. Well, thanks for being on the podcast and for the mini lesson in lips, which we didn't know was going to happen, but that was awesome. That was super fun to talk about. And we'll see you all next time.

Speaker 1 (26:20):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego freeway in the XIMED building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com, or follow the team on Instagram at LJCSC. The LA Jolla Cosmetic Podcast is a production of The Axis. theaxis.io.